Civil society and accountability; a game-changer for UHC

NSHDP II was launched in January 2019 alongside the BHCPF

Nigeria’s Second National Strategic Health Development Plan, was launched early this year alongside the long-awaited Basic Health Care Provision Fund. These strategies have the potential to transform the nation’s health. In this blog, Olaide Shokunbi and Marleen Vellekoop explain key provisions of the strategies and the role of civil society in ensuring their success.

All things being equal, Nigeria should achieve Universal Health Coverage (UHC) by 2022. There are two main conditions for this. The first is that the nation must fully implement the 2018-2022 Second National Strategic Health Development Plan (NSHDP II) as part of the Nigerian health sector’s overarching plan for improving primary health care and achieving UHC. The second is that plans should be sufficiently resourced with Nigerian funds instead of relying on donor funding. In order to achieve these two conditions, Nigerians and civil society must hold government and other stakeholders responsible for implementing these plans to account.

Government strategies for UHC

On 8 January, Nigeria’s President Muhammadu Buhari launched the NSHDP II and three other documents aimed at achieving this goal, including: the Third Generation Country Cooperation Strategy; the Framework for Reduction of Maternal and Child Mortality in the States; and the HUWE Operations Manual, which is the guideline for the operationalization of the Basic Health Care Provision Fund (BHCPF). Nigeria’s health minister, Prof Isaac Adewole explained that through the plans, the health ministry had prioritised the strengthening of the PHC system to achieve UHC in line with Primary Health Care Under One Roof (PHCUOR).

NSHDPII provides a policy framework that guides national and sub-national governments on health sector priorities. BHCPF, as outlined in the 2014 National Health Act (NHAct), will fund delivery of the Basic Minimum Package of Health Services, including basic emergency obstetric and new-born care (BEmONC). BHCPF will be used to address health through the distribution of 1 per cent of the nation’s consolidated revenue fund to, PHC facilities through the National Primary Health Care Development Agency (45 per cent of the fund), the National Health Care Insurance Scheme (50 per cent), and the Federal Ministry of Health (5 per cent).

With optimal implementation, Nigeria’s health indices should improve substantially over the plan period. Some of the specific targets include:

A 31 per cent maternal mortality ratio (MMR) reduction – from 576 per 100,000 live births to 400/100,000 live births;

A 33 per cent neonatal mortality rate (NMR) reduction – from 39 per 1,000 live births to 26/1,000 live births; and

A 29 per cent Under-5 mortality rate (U-5MR) reduction – from 120 per 1,000 live births to 85/1,000 live births.

Funding and accountability

During the launch of the plans, Nigeria’s President Muhammadu Buhari was the first to acknowledge the importance of accountability. As an avowed anti-corruption crusader, he said: “I am told that very strict accountability and transparency mechanisms have been put in place to ensure there is no corruption in the use of the funds.” Adequate and efficient funding of health plans is an important condition for the success of these plans. In view of the past non-release of substantial parts of allocations to health, communities, civil society organisations, and development partners have an important role in this area.

President Muhammadu Buhari presents 2019 budget to the National Assembly (Photo Credit: @brytedude on Twitter)

Call to action: role of civil society and communities

Civil society and community members, through groups such as ward or facility health committees, will need to work together to make appropriate demands in the following ways:

Make sure you and stakeholders are aware and educated about BHCPF and your roles and responsibilities in making sure funds are disbursed and used as planned;

Work with state governments (in particular the state PHC development agency or board) to ensure they meet the conditions required to receive BHCPF funds and make the necessary financial contribution and commitment required to participate;

Participate in the development of detailed plans for implementation of BHCPF in your State. The plans should be based on the BHCPF/HUWE operations manual, which has clear roles and responsibilities for government departments and agencies, partners, and civil society. These should also include timelines and clear roles and responsibilities;

Hold the federal government accountable for proper resourcing of the BHCPF and advocate for sustained political commitment and transparency by the implementing actors;

Work with the State Primary Health Care Development Agencies (SPHCDA) to reach out to users and providers by providing them information, e.g. through a sensitisation plan and education materials;

Track implementation and timely fund disbursement, document progress, and use this as evidence during advocacy.

Over the last seven years, Evidence for Action has promoted such accountability initiatives by facilitating the creation and implementation of state-led accountability mechanisms (SLAMs) in a number of states with funding from international bilateral donor organisations. Currently, we support SLAMs in Lagos, Bauchi and Gombe states, and have supported PHCUOR advocacy in nine states altogether.

We are gearing up to support the people of Nigeria to achieve the objectives of NSHDP II and BHCPF.